Provider Demographics
NPI:1871833368
Name:SWAYZE, ERIN KRISTINE (LMP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:KRISTINE
Last Name:SWAYZE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SE PARK CREST AVE
Mailing Address - Street 2:STE A120
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-1304
Mailing Address - Country:US
Mailing Address - Phone:360-892-3654
Mailing Address - Fax:360-892-3692
Practice Address - Street 1:225 SECOND STREET
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98639
Practice Address - Country:US
Practice Address - Phone:509-427-4744
Practice Address - Fax:360-892-3692
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60240033225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist